Adolescent Refugees and Migrants: A Reproductive Health Emergency

This 19-page document gives a global overview of the state of young people considered migrants, including internally displaced persons (IDPs), refugees, rural-urban migrants, market traders, seasonal workers, and clandestine migrants. As indicated in the document, the pace of rural to urban migration has significantly increased, particularly in Asia and Africa, challenging governments to deal with disasters causing migration and/or steady urbanisation, both of which are resulting in urban slums and refugee camps.

Transitions occur, as stated here, due to the need to seek refuge or seek economic and/or educational opportunity, or due to coercion related to abduction or recruitment. The health of adolescents in transition can be particularly challenging concerning unsafe sexual and reproductive health (RH) behaviours, which (due to early age of sexual début and low rates of condom and contraceptive use) result in high rates of unwanted pregnancies, sexually transmitted infections (STIs), and HIV/AIDS.

The Inter Agency Working Group on Reproductive Health in Refugee Situations developed guidelines on reproductive health in refugee settings in 1997 (See Related Summaries below: "Reproductive Health in Refugee Situations"). This field manual outlines a Minimum Initial Service Package (MISP) for refugees. In addition, as stated here, "[p]roviders need to understand that not all sexual activity is consensual, as well as the fact that young people’s limited access to information and services contribute to low levels of contraceptive use. Critical services that should be made available to young women include Emergency Contraceptive Pills (ECPs), as well as post-exposure prophylaxis for HIV and STIs for both young women and men. Another service component that must be considered is Postabortion Care (PAC). The precarious situation of young women in displaced settings, including urban slums, suggests an increased likelihood of unsafe abortions and miscarriage."

The following key elements have been identified by organisations providing RH/Family Planning (FP) services to youth:

• "Program planners must pay special attention to the circumstances of youth, noting age, gender, living situation, parental involvement, employment, and socio-cultural norms and influences on behaviour, as well as services available to young people, perceptions of service providers, and young people’s perspectives of their health needs."
• Cultural sensitivities around the provision of RH/FP information and services to youth must be recognised - including sensitising adult gatekeepers to the vulnerabilities of migrant youth.
• Organised activities, such as sports programmes, are recognised as an effective venue for social mobilisation to support health activities, including engaging youth volunteers and disseminating information and referrals.
  
• Multi sectoral approaches that coordinate protection, health, community, skills-building, and education can optimise the approach to marginalised youth, particularly if youth are included in the planning phases. Job creation is important, as well as helping youth develop appropriate and marketable skills.
  
• Training in peer education, leadership, programming, management, communication, and decision-making skills can be relevant strategies.
  
• Since changes in social norms and service delivery cannot be sustained without community participation and ownership of concepts, programsmes, and activities, community involvement is necessary.

As stated here, the focus of the education of adolescents in transitional situations should address youth livelihood needs, including skills relevant to the labour market, entrepreneurship, and a particular emphasis on training for girls. The report recognises education as a stabilising force in unstable environments, and, "[i]mportantly, education improves health and reduces fertility."

In conclusion, the document recommends advocacy for less-visible and hard-to-reach groups of adolescents, particularly those in urban slums, conflict zones, and refugee camps. It favours a donor and government agenda to assure more broad-based and systematic commitment to the needs of adolescents: for refugees, help to develop the necessary skills that will prepare them for repatriation and rebuilding; and for youth and children in urban slums, development of infrastructure, schools, health services, and employment options, in addition to food and security. The issue of migration needs to be factored into demographic, social, and health surveys; and the identification and documentation of programme efforts and best practices need to be disseminated.